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TRICARE Prime vs. TRICARE Standard
Views: 580
Replies to This Discussion
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Permalink Reply by Emily-aaronsgirl11 on
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Hi Brooke!
There are lots of pros and cons to both plans and each person has to weigh them to decide which is best for them.
Tricare Prime you receive almost all your healthcare from a military treatment facility (MTF). You pay no co-pays or shares, but you must receive a referral to go anywhere other than a MTF for any care besides a true emergency.
- Pros:
- No out of pocket cost
- Cons:
- At the naval hospital up here it was often impossible to get appointments in a timely manner. I waited more than 4 weeks on more than one occasion just to get an appointment with my PCM. Now, they would book me with someone else if I needed a same day appointment, but I wanted to see MY doctor because I had a reoccurring problem and this took much longer to get scheduled.
- You have to get a referral from your PCM in order to see any specialist. Dermatologist, podiatrist, etc. Sometimes they do send you off base for a specialist, but it can take a while for these referrals to go through.
Tricare Standard and Extra you can go to any civilian doctor, but must choose in-network in order to keep your co-pays/shares low. This isn't hard in a large military area. You do have to pay some out of pocket costs, but compared to other civilian plans, it is very VERY low.
- Pros:
- You can choose any doctor you wish at any time.
- You do not have to have a referral to go to any doctor. You want to stay in-network, but you can see a specialist without a referral at any point.
- Cons:
- You do have out of pocket costs. However, I have found these to be extremely minimal compared to the stress that Prime caused me. My co-pay for the year is $150 and once I reach that, I only pay 15-20% of the negotiated cost for in-network doctors. I have never seen a bill for more than $20 after I paid my $150 for the year.
So, if you can't tell, I am on Standard and I would never go back. However, like I said earlier, everyone has to choose for themselves. Your decision can also be based on location. Some stations have better hospitals than others. Let me know if you have any other specific questions!
- Pros:
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Permalink Reply by Brooke on
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Wow Emily-Aaronsgirl1 thank you so much for your input!
I was leaning toward standard before and now I am definitely thinking that is the best choice for me. -
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Permalink Reply by WifeofaUSsailor on
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Hello Brooke! I am on Tricare Prime and really like it. I think the biggest thing you have to decide for yourself if whether you prefer on-base care or not. I personally like going to the hospital on base. I don't have a hard time making appointments, although I try to do it at least a week in advance because they sometimes fill up quick. I've seen several doctors at base and all of them have been attentive and over all good doctors. The corpsman are always on point too and very professional. The other thing you have to consider is whether you're okay with paying a small co-pay fee to see a doctor off base. It was really important to me to try to eliminate any extra costs for medical care and get completely free prescriptions. If you do want to do Standard I believe the only service you can receive at the hospital on base is Urgent Care in case of an emergency. But there are pros and cons to each, hope that helps!
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Actually I do have a question. If you're on prime and visit the hospital on base do you have a choice in doctors or do you just see whoever is available?
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Permalink Reply by Anti M on
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They assign a PCM to you, and that is your doctor. You can see others in the clinic if yours is booked, and you can switch if you don't like an assigned doctor.
My biggest problem is they keep sending my docs on deployment, but it is an AF base; the Navy doesn't do that the same way.
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